52 years old and needing help bad

[ironman]

Well I am going to try this again I have been trying to right this for a couple of months and could not focus and stay on task to get it done. I am 52 have been extremely athletic my whole life, grew up in the country and worked very hard. I was always in good shape and strong which is probably what kept me from a broken back, I had an injury several years ago when a machine was dropped on my back which started a lot of my problems. I have had two back surgeries and take a lot of pain meds.
My body didn't change for 20 years I wore the same size pants had a 33" waist I'm 6'4" but now I am putting on fat around my waist and everywhere else I am losing muscle and just skin and bones. I let things go too long before checking testosterone levels, I thought a lot of why I felt the way I do was because of my injuries. What's crazy is that I told several Drs. what was going on with my body and they truly are idiots. I lost most of my hair on top of my head years ago which may have been a sign of what was going on and I just didn't know it, but since I have lost all the hair on my lower legs I still have chest and facial hair but not as thick as it once was
I have so many symptoms and don't know what is causing what, Fatigue I never sleep good always wake up more tired than when I went to bed. Ears ringing, super dry skin, constipation, cold all the time(especially hands and feet) even when it's not cold, eyes blurry(always had good eye sight), Head aches, joint pain and no sex drive. I used to have sex almost daily and I have not had sex in several years, no morning wood no wood ever except sometimes when you need to pee.
I have had tests done 4 times since September and still have not got the Dr to run every test I asked for, trying to get all the ones friends said to get. After several Drs. I wound up at a Urologist and was going to start test and then he says you know you would probably be a good candidate for Clomid, so on 1-10-14 started 25mg of Clomid and 4mg of Flowmax ed. Well now I have acne on my upper arms, delts and even on my butt cheeks so that has to go, I never had acne even as a teenager.
Like I said I'm 52 6'4" used to weigh 255 with 33" waist now weigh 200 or less with fat around waist.
Testicles do ache and I had an ultrasound done, it showed good blood flow but I do have a varicocele but Dr said let it go.
I have been checking my temps and early morning usually 96.1 or 96.3, the highest I have been getting later in the day is 97.3
I used to eat way to much salt and not as much now.
Sorry this is so long but trying to be thorough, now I'll try the labs.
8-29-13
Testos 130.5 280-800 ng/dl
11-12-13 Quest Diagnostics
Testos 202 250-1100 ng/dl
Testos free 23.7 46.0-224 pg/ml
Testos bio 48.7 110.0-575.0 ng/dl
Shbg 35 10-50 nmol/l
Albumin, serum 4.5 3.6-5.1 g/dl
Vitamin D,25-oh,D3 11 30-100 ng/ml *
Vitamin D,25-oh,D2 <4
PSA 0.8 0.0-4.0 ng/ml
FT4 0.59 0.59-1.17 ng/dl
TSH 4.65 0.340-4.820 mIU/ml

CBC
wbc 7.0 4.8-10.8 x10^ 3/ul
rbc 4.83 4.70-6.10 x10^ 6/ul
hgb 13.9 12.0-18.0 g/dl
hct 41.8 37.0-52.0 %
mcv 87.0 80.0-94.0 fl
mch 28.8 27.0-31.0 pg
mchc 33.3 33.0-37.0 g/dl
rdw 12.4 11.5-14.5 %
plt 250 130-400 3/ul
mpv 7.7 7.0-10.0 fl
gran# 5.2 1.9-7.0 3/ul
lymph# 1.4 1.1-2.7 3/ul
mono# 0.4 0.0-1.8 3/ul
gran% 73.9 45.0-70.0 %
mono% 5.7 1.7-9.3 %
lymph% 20.4 20.0-45.0 %
CMP
glucose 98 70-110 mg/dl
bun 7 7-22 mg/dl
creatinine 1.0 0.6-1.3 mg/dl
bun/creat ratio 7.0 calc
sodium 136 136-145 meq/l
potassium 4.0 3.5-5.1 meq/l
chloride 106 98-107 meq/l
carbon dioxide 33 21-32 meq/l *
calcium 8.5 8.5-10.1 mg/dl
osmolality 279.9 280.0-300.0 *
total protein 7.0 6.4-8.2 g/dl
albumin 4.0 3.4-5.0 g/dl
a/g ratio 1.3 0.9-2.0
globulin 3.0 2.2-4.1 g/dl
alk phosphatase 167 50-136 *
alt(sgpt) 56 30-65 u/l
ast(sgot) 45 15-37 *
total bilirubin 0.5 0.0-1.0 mg/dl
gfr caucasion >60

12-19-13
libid profile
cholesterol 155 0-200 mg/dl
triglycerides 62 0-150 mg/dl
hdl cholesterol 37 40-60 mg/dl *
ldl direct 101 0-130 mg/dl
ldl calculated 106 0-130 cal
non hdl cholesterol 118 <130 calc
vldl cholesterol 12 calc
hdl risk factor 4.2 3.0-5.0 calc
CBC
wbc 8.4 4.8-10.8 x10^3/ul
rbc 4.80 4.70-6.10 x10^6/ul
hgb 13.8 12.0-18.0 g/dl
hct 41.0 37.0-52.0 %
mcv 85.0 80.0-94.0 fl
mch 28.8 27.0-31.0 pg
mchc 33.7 33.0-37.0 g/dl
rdw 12.0 11.5-14.5 %
plt 243 130-400 x10^3/ul
mpv 7.9 7.0-10.0 fl
gran# 5.1 1.9-7.0 x10^3/ul
lymph# 2.7 1.1-2.7 x10^3/ul
mono# 0.6 0.0-1.8 x10^3/ul
gran% 59.2 45.0-70.0 %
mono % 8.2 1.7-9.3 %
lymph % 32.6 20.0-45.0 %
CMP
glucose 91 70-110 mg/dl
bun 8 7-22 mg/dl
creatinine 1.1 0.6-1.3 mg/dl
bun/creat ratio 7.3 calc
sodium 146 136-145 meq/l *
potassium 3.3 3.5-5.1 meq/l *
chloride 109 98-107 meq/l *
carbon dioxide 32 21-32 meq/l
calcium 8.5 8.5-10.1 mg/dl
osmolality 299.9 280.0-300.0 calc
total protein 6.9 6.4-8.2 g/dl
albumin 3.9 3.4-5.0 g/dl
a/g ratio 1.3 0.9-2.0 calc
globulin 3.0 2.2-4.1 g/dl
alk phosphatase 163 50-136 mg/dl *
alt (sgpt) 74 30-65 u/l *
ast (sgot) 40 15-37 u/l *
total bilirubin 0.6 0.0-1.0 mg/dl
gfr caucasion >60 > 60 ml/min/1.73m^2

12-19-13 Quest Diagnostics
ESTADIOL, ULTRSENSITIVE 33 High <29 pg/ml * HI

1-20-14 Quest Diagnostics
FSH 2.0 1.6-8.0 miu/ml
LH 6.4 1.5-9.3 miu/ml
Free T3 3.1 2.3-4.2 pg/ml
Free T4 0.61 0.59-1.17 ng/dl
TSH 6.950 high 0.340-4.820 miu/ml *
Cortisol, total 19.7 mcg/dl (taken about 3:00 pm) *?
Range for 8am 4.0-22
Range for 4pm 3.0-17.0
BMP
glucose 91 70-110 mg/dl
bun 6 L 7-22 mg/dl *
creatinine 1.2 0.6-1.3 mg/dl
bun/creat ratio 5.0 calc
sodium 143 136-145 meq/l
potassium 3.3 L 3.5-5.1 meq/l *
chloride 105 98-107 meq/l
carbon dioxide 33 H 21-32 meq/l *
calcium 8.6 8.5-10.1 mg/dl
osmolality 293.2 280.0-300.0 calc
CBC
wbc 5.5 4.8-10.8 x10^3/ul
rbc 4.76 4.70-6.10 x10^ 6/ul
hgb 13.8 12.0-18.0 g/dl
hct 40.4 37.0-52.0 %
mcv 85.0 80.0-94.0 fl
mch 28.9 27.0-31.0 pg
mchc 34.1 33.0-37.0 g/dl
rdw 11.9 11.5-14.5 %
plt 232 130-400 x10^ 3/ul
mpv 7.3 7.0-10.0 fl
gran# 3.2 1.9-7.0 x10^ 3 /ul
lymph# 1.8 1.1-2.7 x10^ 3/ul
mono# 0.5 0.0-1.8 x10^ 3/ul
gran% 56.4 45.0-70.0 %
mono% 9.2 1.7-9.3 %
lymph% 34.4 20.0-45.0 %
I did start taking Vit D3, Fish Oil, Flaxseed, and Milk Thistle for my liver on 12-1-13
Sorry for the long book, any help with this mess will be greatly appreciated.

 

[Bass]

well as I was reading your story I immediately thought Thyroid is probably one of your problems, and your BW shows it. taking pain killers and other medications can hinder your testosterone production, also put stress on your liver and that why the elevated enzyme. in my opinion at your age and all the symptoms, BW and injuries you are a good candidate for TRT, but you need to be seen by a knowledgeable doctors to treat you properly. supplementing won't do much at yours stage but they won't hurt either, might as well get used to them as it will be part of your complete TRT protocol. hope you get this resolved soon so you can get your life back.

 

[ironman]

Bass, Thanks for the quick response and believe me I understand what you are saying. It has taken several months to get to this point and finally thought I had a doctor that was going to deal with my TRT, told me to try the clomid and then if that didn't work he would start me on injections. Well after phone tag for the last week his nurse informs me yesterday that he thinks I need to see an Endo and when I asked why he wasted another month of my time before telling me that, she said because my E2 was already elevated he didn't feel comfortable give me testosterone. I was like yea there are ways to deal with that. So I am back at square one trying to find a doctor. Again thank you for the advice.

 

[Bass]

unfortunately its a journey most of us go through, once you find the right doc you'll be GTG. keep us posted.

 

[Vettester Chris]

IronMan, thanks for posting your labs. There are a lot of variables here, so it's best (on my end) to grab one or two, then can address more later ...

OK, starting with the testosterone and feedback loop side of it ... Your latest labs in Jan show a good LH value. FSH is pretty low, but LH would be the ticket for signalling the Leydig cells for more testosterone production. I don't see a supporting testosterone serum value (maybe I'm missing it). My concern with this is that you mentioned that you started Clomid on the 10th of Jan. I don't see any previous LH/FSH values, so it's difficult to say. If you LH was low before the Clomid therapy, then you present a 'Secondary' diagnosis. Maybe you can elaborate a little more?

I suspect adrenal issues, but that Cortisol serum lab you provided doesn't tell me much. Please look into getting a 4x Saliva Kit from Canary Club/ZRT, or another place.

We also need to see more thyroid information ... Reverse T3 & Antibodies (TPO & TgAb). Your T3 demand is high and obviously T4 production is low. I suspect iron and possibly ferritin issues, and seeing your low potassium is also a marker that thyroid activity at the cellular level is probably not optimal. You're definitely on the right track with starting Vitamin D (yours is quite low). Maybe look at 5,000iu/day (min), or talk to your physician about getting a prescription for Drisdol. So back on the labs, look into the iron (TIBC, transferrin sat%, total iron serum) B12, magnesium, the cortisol mentioned above, and DHEA.

Suspecting your liver enzymes are elevated due to the pain meds. It's just the nature of it if you're taking quite a bit and/or adding alcohol, or other compounds that are hepatotoxic.

 

[ironman]

Chris first let me say thank you for the most in depth response I've had. With that let me say I tried to get the tests done before taking things that would change the results, but as far as the clomid I took 25 mg a day for 6 days until 1-15-14 and then stopped until after the 1-20-14 test. I don't know how much 6 days would change it. I know the cortisol test doesn't show much other than it was just a little high that afternoon which I don't even know what it should be. No alcohol at all, something changed the sodium and potassium numbers after Novembers test on the last two. I'm sorry it has taken me this long to respond to you but we have had snow storms that we are not used to and really I have been miserable and freezing and could not make myself get this done. I'm going tomorrow and have more tests on thyroid, cortisol testosterone and E2 again, I don't know what other tests they will do. On a side note the Urologist would not start me on T after he said to try the clomid for a coulple of weeks and if it didn't help he would, when I asked why he said my E2 was already elevated so he didn't feel comfortable with giving it. I told them there are ways to deal with it and he says go to an Endo. Again let me say thank you to you and anyone that might have some answers with my mess.

 

[Vettester Chris]

You're welcome, Ironman! The cortisol test you provided us really doesn't say much, and the accuracy isn't anything I'd want to hang my helmet on. Do it right and get the 4x Saliva Kit from Canary CLub or ZRT. We need to see where you morning start-up is and see the trend throughout the day. I can help you put together a circadian path chart with DHEA placement to give you a really good idea where you sit. It's up to you to grab the horns and run with it.

I think you need to do a little more doctor recon program to get someone who can embrace your relevant situation. I think you're getting the ole brush off, but that's my .02.

 

[ironman]

Thanks Chris, I'm sure you are right about the Dr run around I don't know if they are scared of the latest publicity about testosterone or what it is. They tried for over a month to try and find an Endo to send me to (there's not even an endo in my town) and finally found one and could get me an appt. in August in another state it's crazy. I'm working on the 4x Saliva test, but I have had some more test ran on 2-19-14 and a couple of things jump out one my Tsh is going crazy at 11.140 now. My Testosterone was 571 up from 202 and the only thing changed was taking 5000 iu of D3 and the clomid I took 25mg a day from 1-10-14 thru 1-16-14 and then started again 1-20-14 thru 1-29-14 and I don't know if that was enough to restart or if it just temporarily raised the numbers but I feel just as crappy as always. My E2 also has went up even more so that I'm sure is part of the way I feel. Anyway here's the new numbers that I have, any help would be great Thanks again.


2-28-14
Thyroid Peroxidase Antibodies 233 <35 iu/ml *

2-19-14
Testosterone 571 250-1100 ng/dl
Free Testosterone 61 46.0-224.0 pg/ml
Bioavailable Testosterone 128.1 110.0-575.0 ng/dl
SHBG 44 10-50 nmol/l
Albumin Serum 4.6 3.6-5.1 g/dl
Estradiol, Ultrasensitive 44 <29 pg/ml

TSH 11.140 0.340-4.820 miu/ml
Free T4 0.83 0.59-1.17 ng/dl
Free T3 3.0 2.3-4.2 pg/ml
Reverse T3 LC/MS/MS 23 8-25 ng/dl

FSH 3.4 1.6-8.0 miu/ml
LH 4.6 1.5-9.3 miu/ml

Cortisol, Total Fasting 9.2 4.0-22.0 mcg/dl

Prolactin 14.5 2.0-18.0 ng/ml

CMP
Glucose 89 70-110 mg/dl
BUN 7 7-22 mg/dl
Creatinine 1.2 0.6-1.3 mg/dl
BUN/Creat Ratio 5.8 Calc
Sodium 144 136-145 meq/l
Potassium 3.4 3.5-5.1 *
Chloride 108 98-107 meq/l *
Carbon Dioxide 33 21-32 meq/l *
Calcium 8.2 8.5-10.1 mg/dl *
Osmolality 295.4 280.0-300.0 Calc
Total Protein 7.6 6.4-8.2 g/dl
Albumin 4.3 3.4-5.0 g/dl
A/G Ratio 1.3 0.9-2.0 Calc
Globulin 3.3 2.2-4.1 g/dl
Alk Phosphatase 108 50-136 mg/dl
ALT (SGBT) 49 30-65 u/l
AST (SGOT) 31 15-37 u/l
Total Bilirubin 0.7 0.0-1.0 mg/dl
GFR Caucasion >60 >60 ml/min/

LIPID PROFILE
Cholesterol 154 0-200 mg/dl
Triglycerides 74 0-150 mg/dl
HDL Cholesterol 33 40-60 mg/dl *
LDL Direct 102 0-130 mg/dl
LDL Calc 106 0-130 Calc
Non HDL Cholesterol 121 <130 Calc
VLDL Cholesterol 15 Calc
HDL Risk Factor 4.7 3.0-5.0 Calc


WBC 7.4 4.8-10.8 x10^3/ul
RBC 4.91 4.70-6.10 x10^6/ul
HGB 14.3 12.0-18.0 g/dl
HCT 41.9 37.0-52.0 %
MCV 85.0 80.0-94.0 fl
MCH 29.1 27.0-31.0 pg
MCHC 34.1 33.0-37.0 g/dl
RDW 12.5 11.5-14.5 %
PLT 259 130-400 x10^3/ul
MPV 7.7 7.0-10. fl